Educators are increasing enrollment in medical and nursing schools and urged legislators to create more residency programs, saying young doctors are likely to stay in the states where they complete their medical training.

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Telemedicine, using video equipment to allow doctors in one location to examine and treat patients with the help of a trained assistant in another location, can help. So can the increased use of advanced practice nurses and physicians' assistants.

Loan repayment programs, which repay student loans for doctors who agree to work in underserved areas, have been successful, Ragain said, but he noted that the Legislature cut funding for the program in 2011.

Few residency slots

Doctors often remain in areas where they complete their residencies, he said, but Texas has too few slots.

Residency programs are expensive, costing about $150,000 a year per resident. Medicare is the primary funding source for that, but funding has been essentially frozen since 1996. Rep. Garnet Coleman, D-Houston, said a groundbreaking project still in the planning stages could help.

The project, known as a Medicaid 1115 Waiver, will allow Texas to obtain more federal money in exchange for finding better ways to provide care. Some of it will go to reimburse hospitals for providing charity care.

Transparent system

Texas Health and Human Services Commissioner Tom Suehs told committee members that planning is under way and should ensure that hospitals reimbursed for providing charity care actually deserve the money.

The previous system was less transparent. This program will provide a better idea of which hospitals actually provide indigent care, Suehs said.

Legislators, including committee chairwoman Lois Kolkhorst, R-Brenham, worried about what will happen when the waiver period ends in 2016.

Suehs tried to assure them that the federal government would extend the program.

The first milestone will come later this week. Suehs said he will determine which counties will work together following a public hearing in Austin Thursday.

Most of the counties have already informally made that decision on their own, he said.

Harris County Hospital District President and CEO David Lopez said last week he expects Harris County to be joined by Austin, Brazoria, Calhoun, Chambers, Colorado, Fort Bend, Jackson, Matagorda, Montgomery, Waller and Wharton counties.

The waiver program could bring the state as much as $29 million over the next five years, and Coleman said some of that money could be used to pay for additional residency slots for new medical school graduates.